A systematic review of maternal and infant outcomes following magnesium sulfate for pre-eclampsia/eclampsia in real-world use

Int J Gynaecol Obstet. 2012 Aug;118(2):90-6. doi: 10.1016/j.ijgo.2012.01.028. Epub 2012 Jun 15.


Background: Evidence from RCTs shows that magnesium sulfate reduces the risk of seizures and mortality for women with pre-eclampsia/eclampsia. However, it has been argued that outcomes within trials may not reflect real-world outcomes with the same intervention.

Objective: To assess whether outcomes for women with pre-eclampsia/eclampsia who received magnesium sulfate in the real world were comparable to those in RCTs.

Search strategy: EMBASE and MEDLINE were searched (January 1990-July 2010).

Selection criteria: Cohort, before-and-after, and serial cross-sectional studies were included. Participants were women with eclampsia who received magnesium sulfate or another anticonvulsant, and women with pre-eclampsia who received magnesium sulfate or no anticonvulsant. Primary outcomes were death (maternal, fetal, neonatal) or recurrent seizures.

Data collection and analysis: Data were extracted independently by 2 reviewers.

Main results: Six studies (1831 women with eclampsia) were included, from academic centers in Bangladesh, India, Pakistan, and Nigeria, together with 2 population-based UK studies. Magnesium sulfate for eclampsia was associated with lower risks of maternal death, recurrent seizure, and major morbidity; for pre-eclampsia, it was associated with lower risks of eclampsia.

Conclusion: Improvements in maternal outcome with magnesium sulfate for pre-eclampsia/eclampsia in real-world use are comparable to those reported in RCTs.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Anticonvulsants / therapeutic use*
  • Eclampsia / drug therapy*
  • Eclampsia / mortality
  • Female
  • Humans
  • Magnesium Sulfate / therapeutic use*
  • Pre-Eclampsia / drug therapy*
  • Pregnancy
  • Seizures / prevention & control


  • Anticonvulsants
  • Magnesium Sulfate